Nasopharyngeal cancer: Incidence and prognosis of human papillomavirus and Epstein-Barr virus association at a single North American institution.

Background: The prognostication of Epstein-Barr virus (EBV) and human papillomavirus (HPV) status in nasopharyngeal cancer (NPC) is unclear.
Methods: This retrospective study analyzed NPC from 2000 to 2019.
Results: Seventy-eight patients were included: 43 EBV ⁺ , 12 HPV ⁺ , 23 EBV ^- /HPV ^- , and 0 EBV ⁺ /HPV ⁺ . All p16 ⁺ tumors were also positive for HPV-CISH. Baseline characteristics were not different between groups except age, N-classification, and Karnofsky Performance Scale (KPS) (p < 0.05). For EBV ⁺ , HPV ⁺ , and EBV ^- /HPV ^- respectively, 3-year overall survival (OS) was 89.9%, 69.8%, and 52.5% (p = 0.006). EBV ^- /HPV ^- status was significantly associated with worse OS but not freedom from progression (FFP) on univariate analysis, and did not remain a significant predictor of OS after adjusting for KPS, age, and group stage.
Conclusions: EBV ⁺ NPC tumors were seen in younger, healthier patients than HPV ⁺ and EBV ^- tumors, and there were no cases of coinfection. The association of viral status with OS was insignificant after adjusting for KPS and age.
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